Pacemaker Implantation Surgery Cost in Bangkok

A pacemaker is a tiny, battery-operated device that ensures your heart beats at the right speed. Surgery is required to implant the pacemaker, usually beneath the skin near your collarbone. It's also known as a cardiac pacing device.

A pacemaker implant is a small device that weighs around 20 g to 50 g and is the size of a matchbox. It has a pulse generator with a battery, a tiny computer circuit, and a few wires called pacing leads. This system is attached to the heart and it emits signals through the wires. The pacing rate or the rate of electrical impulses can be adjusted as per the requirement of the body and be accordingly programmed. It can sense if a heartbeat is missed or if the heart is beating too slowly. Accordingly, it starts sending a steady signal to normalize the beating of the heart. If the beats are normal, then it simply does not send any signal.

A pacemaker might be necessary if:

• You have chronic heart failure, which is characterized by a prolonged, weak, or irregular heartbeat.
• A pacemaker only activates when it detects irregular heartbeats. For instance, the pacemaker can adjust the heartbeat by sending electrical signals if it beats too slowly.

Pacemakers come in various types:

• Single Chamber Pacemaker: Sends electrical signals to the lower right chamber of the heart.
• Dual Chamber Pacemaker: Sends electrical signals to both the upper and lower right heart chambers.
• Ventricular Pacemaker (Cardiac Resynchronization Pacemaker): Designed for individuals with heart failure and a slow heartbeat.Stimulates both lower heart chambers to strengthen the heart muscle.

1. The pacemaker insertion process involves a minimally invasive procedure with transvenous access, commonly through the subclavian or cephalic vein. This provides access to the infraclavicular region for subcutaneous placement of the pacing generator. Pacemaker leads are surgically implanted via thoracotomy, positioned in the abdominal area. Antibiotic prophylaxis is administered for infection prevention. Percutaneous central vein access, along with fluoroscopic examination, ensures accurate placement.
2. Guidewire placement is crucial, with access to the subclavian vein and advancement to the right atrium or vena cava. Fluoroscopy aids visualization, and phlebography confirms deep vein thrombosis. Subsequent subclavian vein access and guide wire advancement facilitate lead placement.
3. Pacemaker lead implantation involves creating an incision and subcutaneous pocket for the pacemaker generator. A special sheath and dilator are advanced over the guide wire, facilitating the insertion of the lead-style combination. Fluoroscopy guides the positioning of leads, and measurements of lead impedances are taken, followed by testing.
4. The securing of the lead involves suturing the proximal end to the pectoralis tissue, and the pulse generator is connected to the leads. Surgeons often secure the generator to the tissue to prevent migration. A final fluoroscopic confirmation of lead positioning precedes the closure of the incision.
5. Post-procedure care includes the application of a sterile dressing, and patients are advised to limit movement for 12 to 24 hours. Surgeons may employ adhesive strips and absorbable sutures for incision closure.

Usually, a patient is kept under observation for more than a day after the pacemaker implantation surgery. It takes around six weeks for the patient to get used to the implanted device. Heavy work must be avoided initially. One should ensure that the concerned arm is not rendered immobile during this time to prevent a frozen shoulder. A physiotherapist can exactly show the movements that you need to perform to keep your arm healthy. Carry the duly filled pacemaker implant card for emergencies to avoid any unwanted situation.